• Julianne Arena, MD

4 Barriers to Weight Loss for Women over 40

As a practicing OB/GYN physician for over fifteen years, I have seen countless women struggle with their weight. Losing weight is especially difficult for women over 40. The conventional adage “just eat less and exercise more,” is old school and out of date. Many women eat well and exercise regularly after forty and still see the numbers on the scale climb. It is a frustrating paradigm that leads us to seek alternative explanations.

Let’s discuss four concepts that look outside the conventional box.

Hormone Imbalance

This topic alone is large enough to fill pages and even books, and I would not be a thorough women’s health expert if I didn’t impress its importance here. As we age, our hormones shift, creating imbalances. And by hormones, I don’t mean just the typical sex steroid hormones of estrogen, progesterone and testosterone. We also need to think about what’s happening with cortisol (our stress hormone), glucose regulation and insulin, and the thyroid. All of these hormones work together and need to be in balance in the hormone symphony. If one of these players is off or out of tune, the result is disharmony, and the whole symphony is thrown off. One example of this is when cortisol rises, the amount of thyroid hormone produced falls. Low thyroid production can lead to fatigue, hair loss and weight gain.

Conventional exploration of these perimenopausal concerns often includes basic bloodwork, such as checking only a TSH (thyroid stimulating hormone), and the reassurance that what we are experiencing is a "normal part of aging." A birth control pill and a mood medication are often prescribed as a band aid or a quick fix. However, this is the time when we should be seeking a deeper, more thorough evaluation of how to balance our hormones. This can be done by doing more extensive blood work, saliva and urinary testing. In viewing the full picture and seeing people as individuals, we can work together to achieve "optimal" levels so we can start feeling better. Our body is our symphony and we want it to play beautifully.


Who doesn’t have stress? It is rampant, universal and unavoidable. We can’t change the stress we are exposed to, but we can try to change how we perceive and respond to it. When we are stressed, our brain tells our adrenal glands to release the hormone cortisol. It is our life saving hormone. It protects us and directs our fight or flight response. Our challenge is that women often stay in this fight or flight response, running on the hamster wheel, for more hours in the day than our bodies were designed to handle. When our cortisol is persistently elevated, it shifts that hormone balance and increases insulin. Cortisol's main job is to raise glucose levels. Short term and long term elevations in cortisol raise blood sugar, and insulin increases to try and keep up. This increase in insulin drops our blood sugar which causes sugar cravings. Over time, this persistently elevated insulin leads to insulin resistance, a condition in which the cells become less sensitive and less responsive to it. Insulin resistance increases age-related diseases such as diabetes, heart disease and cancer.


Sleep is foundational. Most of us don’t get adequate sleep. Everyone’s needs vary, but seven to nine hours is optimal. During sleep, our bodies go into rest and digest mode, and our brains and bodies repair and restore for the next day.

Unfortunately, we live in a culture in which sleep is not a priority and we pride ourselves on functioning on the minimal. We live on our cell phones and computers until late in the night. We binge watch our favorite shows as our “down time” then expect for sleep to happen the moment our head hits the pillow.All of that blue light exposure and activity signals the brain that it’s time to be awake, so our cortisol does not decrease and our brain does not kick on the production of melatonin, our “sleep hormone”. Our brain receives the message that this is not a time to rest and restore.

The concept of sleep hygiene focuses on the importance of training ourselves to prioritize a healthy sleep routine. Suggestions for a healthy routine include shutting off all cell phones, computers and TVs one to two hours before bedtime, keeping the lights dim, and creating an environment that is calm and peaceful. Soaking in an epsom salt bath with lavender oil is also a great way to allow the body to relax.

Inadequate nutrition/fat intake

As a result of that old adage, “just eat less and exercise more,” we often do ourselves a disservice by depriving ourselves of adequate nutrition. Whichever food plan we follow, we need to make sure we are not too restrictive. We need to eat the rainbow of fruits and vegetables and choose foods that contain key nutrients including magnesium, Vitamin B12, selenium, iodine, zinc, CoQ10 and carnitine. These are building blocks for a healthy functioning body. If we are deficient in key nutrients, we lack energy and fuel for the day. Our cravings kick in and then we may go for the sugar and the chocolate as a quick fix and energy boost.

Besides needing adequate nutrients, we also need adequate healthy fats. The 1980’s and 90’s gave rise to the high carb, low fat era. We substituted sugar for fat and we now have an ever-increasing epidemic of obesity and diabetes on our hands. Fats like olive oil, avocados, and nuts are good for our brain and produce far more energy that carbs do. Healthy fats shut down cravings and accelerate weight loss and can prevent and reverse heart disease.

If you’re thinking— “I’m perimenopausal; I need to eat healthy fat, sleep more, stress less AND balance my hormones. That’s quite a to do list!”—take a long, slow, deep breath. Realize that this is a journey. Where we are now did not happen overnight. All of these concepts work together, and trying to find that balance will have our body’s symphony playing at its best.